Outlook and Attitude

Discuss the complexity of working with clients who are also pregnant. How would a pregnancy change your approach to treatment? What issues might come up for you as a counselor? How might you talk about these risks with your client? How would you respond if your client continued to heavily drink or use substances while pregnant?

I have to be perfectly honest, I was thinking long and hard about how I would feel sitting down with a person who while pregnant, abused drugs or alcohol. Years ago, I would have judged them, and treated them with disdain. Now that I have some cursory knowledge of addiction, and the effects of it, I have changed my tune. I am pretty sure I would feel a little upset. Yet, I would also remember that no mother wants to harm her unborn child if she is thinking properly. There has to be issues going on here. Comorbidity would immediately come to mind. I would harken back to my textbook and think about the Biological, Psychological, and Social aspects to consider while trying to understand, and connect with the client.
Furthermore, I would explain to the client the ramifications that her actions have on her life, and the life of her child.
Fetal Alcohol Syndrome (FAS) is a preventable form of mental retardation. It can cause all sorts of developmental problems for the child.
According to Capuzzi and Stauffer (2012), “Addicted pregnant women might also deliver prematurely, experience vaginal infections, and suffer miscarriages.”

If my client continued to drink alcohol or abuse drugs despite my best efforts, I would explain to her that their may be options for her to go and get specialized help for her problems. I would try to reassure her that all involved have her, and her unborn child’s interest at heart, and that we could work together to accomplish her goals. I would try to get her to a facility that could not only provide treatment for her, but would also be supportive of her if she has a family, for her childcare needs. Cost may be a prohibitive factor to consider.

I feel that it is my duty as a human being to seek justice for those who cannot do it for themselves. I do not care what ethnicity, gender, or sexual orientation that person is. I think of it as basic humanity.
The reason I got into this field was to hopefully be used as a resource or tool, for those whose voices may not have a chance to be heard under normal circumstances.

Here are a few websites that have specific information on addictions counseling for the LGBT community.

http://www.new-hope-recovery.com/center/lgbt-program/
I liked this program because they specifically mentioned that because of fear or prejudice, many in the LGBTQI community may not seek help for addiction at traditional facilities, and emphasizes that their staff “strongly believe in the diversity of the individual and honor their dignity and self worth.” They took pains to mention that they provide a safe and supportive environment, and list all the programs that they have to offer.

http://www.lionrockrecovery.com/online-intensive-outpatient/lgbt-friendly-addiction-treatment/
What I really liked about them is that they took insurance. Not everyone can afford to pay $150-$200 per session to see a counselor. Also they seemed to have put some thought into working with people who have real jobs. The company offered convenient schedules, in the day or evening in order to accommodate people. They also emphasized their cultural competence. From the looks of their team bio’s, they seem to have an array of experience in various forms of addictions treatment.

http://www.thecentersd.org/programs/behavioral-health-services/
I liked these guys because they mentioned the violence that the LGBTQI community faces, and mens sexual health, and substance abuse (especially methamphetamine use), counseling, and relapse counseling for those in need. Since San Diego is a military town, they took it upon themselves to add a LGBT Veterans Wall on their website, to honor those who sacrificed for their country. Very cool.

https://www.nalgap.org
This is a site with information throughout the country, and their mission statement.

The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies is a membership organization founded in 1979 and dedicated to the prevention and treatment of alcoholism, substance abuse, and other addictions in lesbian, gay, bisexual, transgender, queer communities.
mission is to confront all forms of oppression and discriminatory practices in the delivery of services to all people and to advocate for programs and services that affirm all genders and sexual orientations. NALGAP provides information, training, networking, and advocacy about addiction and related problems, and support for those engaged in the health professions, individuals in recovery, and others concerned about the health of gender and sexual minorities.”

I am sad to say, that I have not found a lot of counseling services tailored to the LGBTQI community. I hope this changes in years to come. It is very disheartening. I hope that I can be a part of the change that the community, and the country needs.

A quote from Michael Shelton, “62 programs in the entire country offer specialize treatment for LGBTs? We obviously have a lot more work to do. The Joint Commission, an independent not-for-profit organization that accredits and certifies more than 19,000 health care organizations and programs in the United States, concluded that the “8.8 million lesbian, gay, and bisexual people now estimated to be living in the United States experience disparities not only in the prevalence of certain physical and mental health conditions, but also in health care due to lack of awareness and insensitivity to their unique needs.”

Reference:

Capuzzi, D. & Stauffer, M. (2012). Foundations of addictions counseling (2nd ed.). Upper Saddle River, NJ.: Pearson Education, Inc.

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Session 11: “A Little Bump Helps To Even Me Out”

What were your attitudes toward use of substances when you were a
child and an adolescent?

When I was a child, I had no idea what drugs were. I was blind to the world of substances, and it wasn’t on my radar until about the age of 14. That was around the time when my older brother, who was five years older than me, started hanging out at our house with his friends.
I would listen intently to their conversations about girls, parties, and drugs.
It was also and age where I had more free time after school to hear friend’s gossip about unsupervised parties where alcohol, and marijuana were being consumed.

I was say my attitude ranged from curiosity, to indifference. I did not use drugs, and only drank a few times as a teenager.

What was your personal and peer group experience of substance use?

I can vaguely remember the first time I saw a group of friends smoke marijuana. I was about 17, and we were in a friend’s basement (how cliché), and a couple of the guys asked me if I knew how to roll a joint. I told them yes (that was a lie), and proceeded to ruin five to six paper cigarettes. After finally realizing that I had no idea what I was doing, they took it upon themselves to show me. I watched them as they kept insisting that I try some of their pot.
I knew it was wrong. I knew that I should have gotten up, and left that instant. I could not help but think how much drugs cost, and why they did not seem to be as high as I though they should be. I just think I watched too many Cheech & Chong movies. I thought it would be a wild and crazy time when people got high. I did not see the hi-jinx ensue once they finished inhaling.

I have been at numerous parties where drugs were being consumed a few times during my life. It is sort of strange to think about it now. I was living in Los Angeles, and there were several gatherings where cocaine was being snorted, and alcohol being swallowed by the keg. I did not get it. I could not understand how a person who would not give you a bite of his $3.00 burger, would be so insistent for you to take a free snort, pull, or swig of his expensive substance. It still boggles my mind. It is so expensive, why would you share it? Why not keep it all to yourself?

I was having dinner at a friend’s house in D.C. this weekend, and a guy I had never met, decided he wanted me to know about his drug use. He mentioned that he was on disability. We went on to discuss him being wounded in Afghanistan, his current battle to get bigger disability checks from the Veterans Administration, and how snorting cocaine helped to even him out, after a night of too much drinking. I found the entire conversation enlightening.

How are your views the same or different now?

I’ve tried alcohol in the past. I do not really like the taste of it, so I just don’t drink it. I will drink a quarter glass of wine every 6 months or so. But that is very rare.
I think marijuana should be legal. I think hard drugs like cocaine, and heroin should be decriminalized, and regulated by the government. I do not do drugs, and do not plan to do them in the future. It has absolutely no appeal to me.

There was a time where I could not understand how a person could not just stop using. I have learned more about why people have such a hard time stopping their drug use, and I am more definitely more empathetic. I have seen the devastation that mass incarceration, and draconian drug laws for (powered versus crack cocaine) have done to African-American and Latino communities in the U.S. “Black youth are arrested for drug crimes at a rate ten times higher than that of whites. But new research shows that young African Americans are actually less likely to use drugs and less likely to develop substance use disorders, compared to whites, Native Americans, Hispanics and people of mixed race.”
I take it much more seriously now than I did when I was teenager.

What might it feel like to work with clients making different choices, or to encourage choices that you did not make?

I think it was would be sort of like listening to the reasons the gentleman at my friends dinner was giving me for his drug use. I did not pass judgment on him. I just took a moment to listen to what he had to say. I was actually trying to gain a better understanding of his substance and alcohol use.
This is the type of approach I would take with clients as well. Start with listening, then go from there. I am not interested in trying to give advice, I am interested in learning the best ways to help them on the road to recovery, and lead a more healthy and productive life.

Who advised you about drugs and alcohol, and when? What was your response? What encouraged or discouraged use in the approaches you encountered? What do you hope to emulate or discard from your models?

I learned about drugs and alcohol through friends, acquaintances, and life lessons. You learn a little bit about it in school. Yet, there is no substitute for learning about the ramifications of substance abuse in real life situations. I have always been scared of drugs, and the effects they have on the body and mind. I was did not need anyone to discourage me from abusing substances. I have been acutely aware of the sometimes lethal effects of substances. If someone told me that something I did was not going to benefit my life, and may cause quite a bit of emotional, financial, and physical distress for myself, I wanted no part of it.
What I learn from people who have had substance abuse problems is to be careful about my own mental well being. I have seen some of the mistakes they and others have made in life, and I do my best to learn from them. I try to remain in tune to the problems in my own life, while doing my best to surround myself people who are living their lives in a way that minimizes the use of drugs, and alcohol.

Reference:

http://healthland.time.com/2011/11/07/study-whites-more-likely-to-abuse-drugs-than-blacks/

http://www.huffingtonpost.com/2013/09/17/racial-disparity-drug-use_n_3941346.html

http://www.aclu.org/files/assets/aclu-thewaronmarijuana-rel2.pdf

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/04/the-blackwhite-marijuana-arrest-gap-in-nine-charts/

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Session 9: “Self Control Resources”

There have been many circumstances when I have been burning the candle at both ends. Tonight may end up being such a night actually. I worked all day, and I am currently doing homework, and then I have been invited to an small gathering by a friend. I can feel when I’m starting to stretch myself too thin. I start to get short with people in my mind, and then I have a hard time focusing on one task. It usually has to do with school, which ends up taking precedent over anything else I am doing including work, relationships, and sleep. When I lack sleep, I feel completely off, and no matter what I do, I have to have it in order to regain my equilibrium in life. Without the stress triggers of school, I would not feel so discombobulated at times. It does get overwhelming.

I will usually end up not socializing, or going into a sort of “coasting” mode at work, until I can get home to “chant/pray”. Practicing buddhism helps to center me. I find it to be a stress reliever. Once I have finished chanting, I find that I am in a different frame of mind, that allows me to slow my life down to a point where it does not seem so overwhelming.

I believe everyone can find some coping strategies to deal with life’s ups and downs. Some people eat ice cream, treat themselves to a mani/pedi, others go workout. First of all, I feel like I am in tune with myself enough to know when I am not at my best. And secondly, I have come up with the strategies to cope with the stress that life can bring.

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Week 8: “12 Stepping…”

The only part of the 12-step program that relates to my life that I can see is the promotion of “common unity”. This aspect of AA speaks to me in a way that say, it is not all about the individual. It seems to foster a sense of selflessness that I find is beneficial in small group settings.

What it also may do is create a sense of community on a larger scale. At least a sense of openness to the possibility of a more “we are all linked in some way” sort of mentality, that seems to be in short supply sometimes. I also like that fact that the group puts an emphasis on personal responsibility, and that membership is voluntary.

I would actually delete a part. I have been to an AA meeting and I was with someone not of the Christian faith. Yet, at the end of the meeting, the group gathered together to hold hands and recite the Lord’s Prayer. I felt that it may make some people who do not share the Christian faith, that this type of group may not be for them. So I would add a prayer that is similar, or start a group that caters to those who may not want such an overt religious overtones.

I really like the personally responsibility aspect, because it sort of reminds of Glasser’s Reality Therapy. Although I do not subscribe to all the tenets Glasser’s theory, I do like this particular element of it.

I truly the consistency of the 12-step program. According to Capuzzi and Stauffer (2012), “the predictability, consistency, and the opportunity to build social skills without chemical dependence, and the learning of coping skills…lead to effective outcomes.”
The fact that 12-Step programs help clients to recognize that what they are going through is not unusual, then they may start to learn from the struggles and triumphs of their counterparts in the group.

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Week 7: “Pharmacotherapy, medicate, or not to medicate. That is the question.”

“Do you support the use of pharmacotherapy in the treatment of addictions? If so why? If not, why not?”

I certainly support the use of pharmacotherapy in the treatment of addictions if it is in the best interest of my client. If it is not, then I would not be interested in using various drugs to help my client through the addiction process.

I am not a huge proponent of prescribing drugs simply because they are the quickest and easiest solution. There are different factors to consider when proposing what would be best for the client. How long will they have to be on the medication? Are they ways to help the client without having to use drugs? Is the client averse to using drugs, and what are the side effects?

The questions could go on and on. But specifically, I would want to consult with my client, and a physician to do a thorough analysis of the pros and cons, and then let the client decide as to whether or not they were willing to move forward. I must admit if I thought that taking a specific form of medication (methadone), would benefit my client, I would explain to them why I thought that it would be a good thing for them to do. Of course, there are people who become addicted to methadone as well. Oy vey!!!

I know if I was in the hospital, and I was in need of pain medication, I would not hesitate to take it. What I would want to know is if I do take said medication, what are the benefits, and what are the downsides to taking the specific medication. I have heard horror stories of people who have become addicted to pain medication after going into the hospital for various problems.

I just want to emphasize the importance of thinking of my clients well being, is paramount. If you have established a rapport with your client, some may trust you to the point of thinking that you know best. I am not omnipotent. Hence, I would want it to be a collaborative effort on the part of a team of people (including my client), to again, make the decision that is right for them. That way from an ethical point of view, I would feel as though I had most of my bases covered (can you ever have all of them covered?), and everyone can have a sense of confidence moving forward. Yes, it may seem like overkill, yet I prefer to look at it as taking the prospect of prescribing medication as extremely serious.

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Week 6: “The Client Inside Us”

A quote from my text states: “… we get so involved in the role of counselor that we sometimes forget the client inside us. It can become habit to separate ourselves from our clients with a sense of self-righteousness that we do not have the problems they do.”

Do you see this tendency in yourself?

I definitely do. After reading this, and the statement in the text, I had to pause for a moment. I realized that I was not asking myself whether or not I could do what I would be asking my clients to do. If someone told me tomorrow that I had to give up anything that had sugar in it (I realize that drugs are much more serious), could I do it? I think I could. It would be difficult, but I know I could do it. Scratch that. I would like to think that I could do it.

Even now, if my life depended on it (and in some circumstances, people who are addicted face this question), would I have the ability to do what has been proposed? And this does not take into consideration the fact that my brain has been changed by what substance abuse has done (I know sugar has some qualities, but it’s not heroin).

I would stay in touch with my inner client by continuing to become more self-aware everyday. By continuing to study, and through experiential learning (not only from daily life, but from conversation/experiences from people that I encounter), my own self reflection.

It means being more empathetic. Not being too self absorbed.

I try to adhere to the Japanese philosophy of: Kosen Rufu.
means the ceaseless effort to enhance the value of human dignity, to awaken all people to a sense of their limitless worth and potential. I cannot do this by looking at my clients as “us” versus “them”. We’re working in conjunction with each other to create a better environment for all human beings. In the end, most people just want to be happy. I am willing (if they are), to help them start.

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